Healthcare Provider Details

I. General information

NPI: 1679159834
Provider Name (Legal Business Name): LORI EILEEN JOHNSON CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2021
Last Update Date: 02/17/2025
Certification Date: 02/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 WYNTRE BROOKE DR
YORK PA
17403-4535
US

IV. Provider business mailing address

80 WYNTRE BROOKE DR
YORK PA
17403-4535
US

V. Phone/Fax

Practice location:
  • Phone: 717-849-5589
  • Fax: 717-472-8278
Mailing address:
  • Phone: 717-849-5589
  • Fax: 717-472-8278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberSP027041
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberSP027041
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberSP027041
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: